Archived: Dr Vasanti Sandrasagra Also known as Westmount Surgery

Updated 26 July 2016

The practice operates from one site in Eltham, London. It is one of 42 GP practices in the Greenwich Clinical Commissioning Group (CCG) area. There are approximately 2,280 patients registered at the practice. The practice is registered with the Care Quality Commission (CQC) to provide the regulated activities of diagnostic and screening procedures, maternity and midwifery services, and treatment of disease, disorder or injury.

The practice has a personal medical services (PMS) contract with the NHS and is signed up to a number of enhanced services (enhanced services require an enhanced level of service provision above what is normally required under the core GP contract). These enhanced services include improving online access, influenza and pneumococcal immunisations, learning disabilities, patient participation, risk profiling and case management, rotavirus and shingles immunisation, and unplanned admissions.

The practice has an above average population of patients aged 50 to 85 years and over. Income deprivation levels affecting children and adults registered at the practice are below the national average.

The clinical team includes a female lead GP, a permanent long-term male locum GP, a female salaried practice nurse and a female locum practice nurse. The GPs provide a combined total of 13 fixed sessions per week. The clinical team is supported by a practice manager, a senior receptionist, and two administrative/reception staff.

The practice is open from 8.00am to 6.30pm Monday to Friday, and is closed on bank holidays and weekends. Appointments with the GPs are available from 8.30am to 6.30pm Monday to Friday. Extended hours are available from 6.30pm to 7.30pm on Wednesdays. Appointments with the nurses are available from 9.00am to 12.00pm on Mondays, from 8.30am to 12.30pm on Tuesdays and Thursdays, and from 8.30am to 12.30pm and 3.00pm to 7.00pm on Wednesdays.

The premises are arranged over two floors of a converted house. There is a waiting area, a reception area, a consulting room, a treatment room and a toilet on the ground floor. There is a kitchen, an office and a consultation room on the first floor. At the time of our inspection, this consulting room was about to undergo refurbishment and was being used as additional office space.

There is on-street restricted car parking and disabled parking available. The practice’s entrance and toilet are wheelchair-accessible but there are no baby changing facilities, and there is no lift to the first floor.

The practice has opted out of providing out-of-hours (OOH) services and directs patients needing urgent care out of normal hours to contact the OOH number 111 which directs patients to a local contracted OOH service or Accident and Emergency, depending on patients’ medical urgency.

Updated 26 July 2016

Letter from the Chief Inspector of General Practice

We carried out an announced comprehensive inspection at Dr Vasanti Sandrasagra on 12 May 2016. Overall the practice is rated as good.

Our key findings across all the areas we inspected were as follows:

• There was an open and transparent approach to safety and an effective system in place for reporting and recording significant events.
• Risks to patients were assessed and well managed.
• Staff assessed patients’ needs and delivered care in line with current evidence based guidance. Staff had been trained in order to provide them with the skills, knowledge and experience to deliver effective care and treatment.
• Patients said they were treated with compassion, dignity and respect and they were involved in their care and decisions about their treatment with GPs, but they rated the practice below average for several areas of consultations with the nurse.
• Information about services and how to complain was available and easy to understand. Improvements were made to the quality of care as a result of complaints and concerns.
• Patients said they found it easy to make an appointment with a named GP and there was continuity of care, with urgent appointments available the same day.
• The practice had good facilities and was well equipped to treat patients and meet their needs, but there were no baby changing facilities.
• There was a clear leadership structure and staff felt supported by management.
• The practice held regular governance and clinical meetings.

• Practice specific policies were implemented and were available to all staff, but the business continuity plan was not comprehensive.

• The practice proactively sought feedback from staff and patients, which it acted on.
• The provider was aware of and complied with the requirements of the duty of candour.

We saw an area of outstanding practice:

• The practice nurse had won an award from the Greenwich Stop Smoking Service for being the top smoking cessation advisor and for demonstrating enthusiasm and commitment in 2014/2015. The nurse had supported seven out of the 10 patients who signed up for this service to successfully stop smoking. This represented a success rate of 70%, which was above the national average of 51%.

The areas where the provider should make improvement are:

• Ensure all staff receive training on the use of the defibrillator.

• Continually monitor patient feedback, particularly in relation to consultations with nurses, to identify and act on further areas for improvement.

• Ensure regular fire evacuation drills are conducted.

• Ensure the business continuity plan is comprehensive.

• Ensure annual infection control audits are conducted and that they are documented.

• Review the need to have baby changing facilities available.

Professor Steve Field (CBE FRCP FFPH FRCGP) 

Chief Inspector of General Practice

Updated 26 July 2016

The practice is rated as good for the care of people with long-term conditions.

• Nursing staff had lead roles in chronic disease management.

• Performance for diabetes related indicators was similar to the national average. For example, in the previous 12 months 81% of patients with diabetes had well-controlled blood sugar levels (national average 78%), and 79% of patients with diabetes had well controlled blood pressure (national average 78%).

• Longer appointments, home visits and telephone consultations were available when needed. Patients with enhanced needs, and those at risk of hospital admission were identified as a priority.

• All patients with a long term condition had a named GP, and most had a structured annual review to check their health and medicines needs were being met.

• 80% of patients with asthma had an asthma review in the previous 12 months. This was in line with the national average of 75%.

• 100% of patients with chronic obstructive pulmonary disease had a review, including an assessment of breathlessness, in the previous 12 months. This was above the national average of 90%.

• For those patients with the most complex needs, the lead GP worked with relevant health and care professionals on a quarterly basis to deliver a multidisciplinary package of care.

• The practice participated in Greenwich clinical commissioning group’s (CCG) Year of Care scheme, with an aim to improve outcomes for patients with chronic obstructive pulmonary disease, diabetes, heart failure, and hypertension.

Updated 26 July 2016

The practice is rated as good for the care of families, children and young people.

• There were systems in place to identify and follow up children living in disadvantaged circumstances and who were at risk, for example, children and young people who had a high number of A&E attendances.

• Patients told us that children and young people were treated in an age-appropriate way and were recognised as individuals, and we saw evidence to confirm this.

• Appointments were available outside of school hours, and telephone consultations and longer appointments were available if required. Children with enhanced needs were prioritised for appointments.

• The premises were suitable for children and babies, with the exception of the absence of baby changing facilities.

• We saw positive examples of joint working with midwives and health visitors.

• 81% of women aged 25-64 had a cervical screening test in the previous five years. This was in line with the national average of 82%.

Updated 26 July 2016

The practice is rated as good for the care of older people.

• The practice offered proactive, personalised care to meet the needs of the older people in its population.

• Annual health checks for patients aged over 75 years were provided by the practice nurse.

• Nationally reported data showed that outcomes for patients with conditions commonly found in older people were good. For example, 88% of patients with hypertension had well-controlled blood pressure. This was in line with the national average of 84%.

• The practice was responsive to the needs of older people, and offered longer appointments, home visits, and urgent appointments for older people, including those with enhanced needs.

• The practice offered an in-house phlebotomy clinic that could be used by older people who had difficulties in reaching other local services.

Updated 26 July 2016

The practice is rated as good for the care of working-age people (including those recently retired and students).

• The needs of the working age population, those recently retired and students had been identified and the practice had adjusted the services it offered to ensure these were accessible, flexible and offered continuity of care.

• Extended hours appointments were available from 6.30pm to 7.30pm on Wednesdays for patients that could not attend the practice during normal opening hours.

• The practice was proactive in offering online services such as appointment booking/cancellation, repeat prescription ordering and limited access to medical records.

• The practice offered a full range of health promotion and screening that reflected the needs for this age group.

• The practice offered a weekly in-house phlebotomy clinic to facilitate access to this service by working patients.

Updated 26 July 2016

The practice is rated as good for the care of people experiencing poor mental health (including people with dementia).

• Performance for dementia related indicators was in line with the national average. For example, 82% of patients diagnosed with dementia had their care reviewed in a face to face meeting in the previous 12 months (national average 84%).

• Performance for mental health related indicators was above the national average. For example, 100% of patients with schizophrenia, bipolar disorder and other psychoses had a comprehensive, agreed care plan in the previous 12 months (national average 88%).

• The practice regularly worked with multi-disciplinary teams in the case management of patients experiencing poor mental health, including those with dementia.

• The practice carried out advance care planning for patients with dementia.

• The practice had told patients experiencing poor mental health about how to access various support groups and voluntary organisations.

• The practice had a system in place to follow up patients who had attended accident and emergency where they may have been experiencing poor mental health.

• Staff had a good understanding of how to support patients with mental health needs and dementia.

Updated 26 July 2016

The practice is rated as good for the care of people whose circumstances may make them vulnerable.

• The practice held a register of patients living in vulnerable circumstances including homeless people, travellers and those with a learning disability.

• Homeless people were able to register at the practice to receive on-going care.

• The practice offered longer appointments for patients with a learning disability.

• The practice regularly worked with other health care professionals in the case management of vulnerable patients.

• The practice informed vulnerable patients about how to access various support groups and voluntary organisations.

• Staff knew how to recognise signs of abuse in vulnerable adults and children. Staff were aware of their responsibilities regarding information sharing, documentation of safeguarding concerns and how to contact relevant agencies in normal working hours and out of hours.